Provider Demographics
NPI:1962700773
Name:GERIATRIC HEALTH CARE SERVICES
Entity type:Organization
Organization Name:GERIATRIC HEALTH CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-277-6310
Mailing Address - Street 1:1979 CHELSEA JO LN
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-7022
Mailing Address - Country:US
Mailing Address - Phone:865-277-6310
Mailing Address - Fax:865-366-0050
Practice Address - Street 1:135 GENERATION DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-8018
Practice Address - Country:US
Practice Address - Phone:865-277-6310
Practice Address - Fax:865-366-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13185363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514863Medicaid
TN4270888OtherBCBS
TN103G703010Medicare PIN
TN10350I0500Medicare PIN
TN1514863Medicaid